The long-term research goal is to improve patient access to specialist care. The immediate research goals are to design and evaluate technology-enabled models of delivering specialist care to patients with chronic dermatologic diseases. These goals are responsive and relevant to the overall mission of AHRQ because they aim to assess the quality, efficiency, and effectiveness of these technology-enabled models to improve specialist access for all Americans, especially those in rural and medically underserved communities. The research proposal is based on the finding that access to timely, high-quality dermatologic care poses a significant challenge in the U.S. health care system. As a result, many patients with chronic skin diseases lack access to or receive insufficient dermatologic care necessary to improve their overall health and quality of life. In this study, Dr. April Armstrong proposed a novel, online model of delivering direct, follow-up care to patients with atopic dermatitis, a chronic skin disease from which millions of Americans suffer. In this online model, the patients communicate directly with their dermatologists, capture and transmit digital skin images, and receive treatment recommendations and prescriptions from their dermatologists online. This online model could improve patient access to timely medical care and save patients time away from school or work. To evaluate the effectiveness of this online model, Dr. Armstrong designed a randomized controlled trial to compare clinical, quality of life, and satisfaction outcomes of this novel, online model with those of the traditional in-office visits. Pediatric and adult patients with atopic dermatitis will be randomized to either the online group or the in-office group for follow-up management. All subjects will be assessed on their clinical improvement, changes in quality of life, patient satisfaction, and patient knowledge regarding their disease. The use of health information technology to deliver patient-centered care introduces a new model for improving access to specialists. Dr. Armstrong and her mentors expect to demonstrate that patients will be responsible, willing, and active participants in this care delivery system that is enabled by communication technology. This study is also expected to show that patient-directed online care is a practical and effective mechanism to manage skin diseases in follow-up clinical settings. Thus, the research proposed in this application is significant because it is expected to improve clinical outcomes for patients with skin diseases, raise quality of life, and increase patient satisfaction and their knowledge about their skin disease. This model has the potential to be adapted for patients suffering from other types of chronic medical conditions requiring regular follow-up visits to specialists. This research proposal resonates with the AHRQ's mission to use health information technology to support patient-centered care in the management of their health and illness. PUBLIC HEALTH RELEVANCE: The proposed research to study the effectiveness of a patient-centered online model for delivering follow-up specialist care is relevant to public health in several important aspects. This online model will empower patients to be active participants in their health care by enabling them to monitor, document, and communicate their clinical progress with their specialists directly. Patients living in remote areas will have improved access to specialists for follow-up care and save valuable time and costs associated with an office visit. Furthermore, the incorporation of this type of online model into an existing face-to-face practice may help shorten wait times for new patients and patients requesting urgent visits. This research study will yield important findings on clinical outcomes, quality of life measures, and patient satisfaction of this online model compared with the "gold standard" of traditional, face-to-face visits. If the online model for delivering follow-up specialist care is shown to be effective, this patient-centered model has the potential to increase patient access to specialists and improve quality of care for many American's Public Health.